This document provides an overview of group therapy for parents of children with difficult behavior. It discusses assumptions about the causes of behavioral problems and characteristics of inflexible/explosive children. The document reviews the Diagnostic and Statistical Manual (DSM) system for diagnosing psychiatric disorders. It presents a model for understanding the factors that influence misbehavior, including the child's characteristics, parenting style, family stress, and the parents' characteristics. The document also discusses establishing consequences for behavior using the ABC (antecedent, behavior, consequence) model and avoiding rewarding negative behavior. It provides homework and resources for further reading.

1. Group Therapy for Parents of
Children With Difficult Behavior
2: Understanding Difficult Behavior (Part Two)

2. Quick Review – The High Points
 Our Assumptions
 Everybody pretty much does the best they can with what
they’ve got.
 Behavioral Problems start when the demands of the
environment or situation overwhelm kids’ ability to cope.
 Our ideas about the cause(s) of a problem behavior
always guide what we decide to do about the behavior.

3. Quick Review – The High Points
 Inflexible/Explosive Children Typically:
 Are easily overwhelmed
 Have trouble thinking through conflicts
 Have low frustration tolerance and very intense sense of
frustration
 Tend to think in concrete, black-and-white terms
 Have trouble with Executive Functions
 Putting Aside Feelings
 Short-term/working Memory
 Planning/Organizing
 Shifting Gears

4. Quick Review – The High Points
 Inflexible/Explosive Children Typically:
 Have trouble with Sensory Processing
 May be over or under-sensitive to stimuli
 May have trouble “decoding” or understanding stimuli
 We Care About All This Because:
 Most kids with behavioral difficulties tend to be diagnosed
with ADHD—which research suggests is primarily a
problem with Executive Functioning!
 Sensory Processing Problems are often mistaken for
ADHD.
 Sensory Processing Problems often co-occur with ADHD.

5. Meet the DSM!
 The DSM-IV-TR is the American Psychiatric
Association’s big book of diagnostic criteria and
codes. The abbreviation stands for:
Diagnostic and
Statistical
Manual
IV (4th) Edition
Text
Revision

6. Some Cautions:
 Psychiatric Diagnosis is not a perfect science.
 The DSM is designed to classify disorders in terms
of reported symptoms and observed behaviors,
without reference to their cause (“etiology”).
 However, similar behaviors and symptoms may have very
different causes indeed!
 Some criteria can be open to interpretation:
 For example: “often deliberately annoys people ” is one
of the criteria for Oppositional Defiant Disorder.
 How often is “often”?
 How can we be sure a given behavior is deliberate?
 Etc.

7. Diagnosing Psychiatric/Behavioral
Disorders: 5 Axes!
 A complete DSM diagnosis includes an assessment on each
of 5 “axes” or dimensions:
 Axis I: Most Clinical Disorders
 Axis II: Mental Retardation or Personality Disorders
 Axis III: Medical/Physical Disorders
 Axis IV: Psychosocial Stressors
 Axis V: “Global Assessment of Functioning” –a number from 1 to
100.
 A GAF of 30 or below usually indicates need for inpatient treatment
 A GAF of around 70 or above will rarely have need of outpatient treatment
 Most outpatient mental health clients fall in around 55.

8. A Quick Glance at Some Disorders (Axis I)

9. A Quick Glance at Some Disorders (Axis I)

10. A Quick Glance at Some Disorders (Axis I)

11. A Model For Understanding Kids’
Misbehavior
 As we try to get a handle on why our kids
misbehave, it can be useful to explore four factors:
 The Child’s Characteristics
 Physiological/Neurological Conditions – How s/he’s “wired.”
 The Parents’ or Caretaker’s Characteristics
 Physiological/Neurological Conditions – How s/he’s “wired.”
 Family Stress
 Can cause parents/caretakers to be less patient/more punitive—
or less attentive! Can also cause kids to be less patient/more
irritable, less attentive!
 Parenting Style
 What the parents/caretakers do in response to kids behavior.
Doesn’t completely erase the effects of the other three factors,
but can help!

12. So What Can We Change?
 Can’t Do Much About:
The Child’s Characteristics
The Parents’/Caretaker’s Characteristics
Family Stress
 We CAN Make Changes in Parenting Style!
Medication can help,
but we can’t
completely restructure
brains and physiology!
We can teach coping
skills, but we can’t
prevent the world from
making demands on
people!
Parenting style doesn’t cause ADHD or other conditions, but certain
styles can increase or decrease the likelihood of disruptive and
noncompliant behavior.
Remember: “Parenting Style” is simply how we respond to our kids’
behavior. It’s not about being a “good” or “bad” parent, but rather about
efficiently and effectively impacting our kids’ behaviors in the ways that
we want!

13. Behavior Management: The ABCs
Antecedent
(Or Anticipating Action/Event)
Behavior
Consequence

14. Antecedents: Anticipating Behavior
 Prevent misbehavior by making changes in the
setting or environment.
 Example: Making sure dangerous items are out of small
children’s reach!
 Example: Johnny is more likely to do his class work if
he’s not sitting right next to his best friend!
 Example: For Mary, shouting stirs memories of past
abuse. She is more likely to “hear” a reprimand and
correct her behavior if addressed firmly but with a normal
volume of voice.

15. Consequences
 Positive consequences reinforce behavior—they
make behavior more likely to be repeated.
 Negative consequences discourage behavior.
 But…
 If it’s so simple, why is it so hard to manage some
kids’ behavior?

16. Check the “Wiring…”
 Often, the defiant or uncooperative youth has trouble
making the connection between a behavior and its
consequence! Why? Some possibilities that
hopefully sound familiar:
 Problems with Attention
 Problems with Working Memory
 Problems with Receiving or Processing Stimuli
 Problems with Shifting Gears
 Problems Planning/Organizing a Satisfactory Response
 Problems Separating Feelings From the Situation

17. Getting Through
 To Keep the Connection Between Behavior and
Consequence crystal clear, we have to:
 Be Specific About Both Expectations and Consequences!
 Provide Consequences Immediately!
 Especially with kids diagnosed with ADHD!
 Be Consistent!
 Again—With Both Expectations and Consequences!

18. To Be Effective, Consequences Must Be:
 Meaningful to the Youth
 Many kids are motivated more by tangible, immediate
consequences than by intangible, long-term ones: A pat
on the back NOW is worth more than a sense of
accomplishment next week!
 Frequent
 Remember that verbal praise, smiles, and thumbs-up
gestures can all be Consequences! Folks with ADHD in
particular often do well with a near-constant “patter” of
feedback.
 Well-Balanced
 If Negative Consequences continually outweigh Positive
Consequences, most of us will lose our motivation.

19. When We Reward Negative Behavior:
The Coercive Behavior Cycle
 Another reason the ‘ABCs’ ain’t so simple is that we
can often inadvertently reward undesirable behavior!
 Let’s say we ask Bob to Take Out the Trash….
 On a good day, Bob complies--he takes out the trash--and
we get on with our lives:
 But a lot of the time Bob is engrossed in video gaming,
and we repeat our request several times:
Request Compliance
Request Noncompliance

20. When We Reward Negative Behavior:
The Coercive Behavior Cycle (Continued)
 After a while we get irritated and escalate the request with
a few threats, raised voice, etc. In response, Bob
escalates his refusal by shouting back, slamming doors,
etc.:
 At which point we usually do one of two things:
 Try to force Bob to take out the trash
 Give up and take it out ourselves
Request!!! Noncompliance!!!

21. When We Reward Negative Behavior:
The Coercive Behavior Cycle (Continued)
 By and large, Forcing people to do things is
inefficient at best (wastes a lot of energy). At worst,
it escalates into physical violence.
 And “Giving Up” and taking the trash out ourselves
Reinforces Bob’s noncompliant behavior! We are
rewarding Bob for not complying with our directive!

22. Think Before You Make a Directive!
 If you:
 don’t have a consequence planned …
 don’t have the energy to follow through with a
consequence ...
 You might do more harm than good!

23. Homework
 Take a look at your parenting style—particularly
when things don’t seem to be working. Check your
requests/directives—are they specific and clear?
Are your consequences immediate, consistent, and
meaningful to your kid? Are the negative
consequences outweighing the positives and
sapping your kid’s motivation to comply?
 Remember to think through your directives and
consequences.
 Don’t give up!

24. Further Reading / Resources
 Books
Barkley, Russell A. (1995). Taking Charge of ADHD,
Revised Edition: The Complete, Authoritative Guide for
Parents. New York: The Guildford Press.
Barkley, Russell A., and Benton, Christine M. (1998). Your
Defiant Child: Eight Steps to Better Behavior. New York:
The Guildford Press.
Barkley, Russell A., and Benton, Christine M. (1998). Your
Defiant Teen: Ten Steps to Resolve Conflict and Rebuild
Your Relationship. New York: The Guildford Press.

25. Further Reading / Resources
 Websites
 ADHD
 http://www.russellbarkley.org/
 http://www.drhallowell.com/
 Childhood Psychiatric Disorders
 http://www.aacap.org/cs/resource.centers
 Miscellaneous Psychiatric Disorders, Interventions, Etc.
 http://www.wellnessproposals.com/mental-health-library-
index.html